Prioritising on Pandemic Preparedness
COVID-19 social-distancing and travel restrictions have begun to ease or lift in some countries, but the scientific and medical communities are not celebrating. The risk of another pandemic is a statistical certainty; it’s not so much a question of if, but when it will happen.
COVID-19 took the world by surprise when it began spreading at a rapid pace in early 2020. Even the wealthiest countries, most powerful governments and robust healthcare systems were brought to their knees by the deadly virus and its exponential spread around the globe.
But why did this happen, when epidemiologists and scientists had been studying the possible emergence of a deadly coronavirus pandemic for decades?
According to an in-depth report published by the Independent Panel for Pandemic Preparedness and Response (IPPPR), “the combination of poor strategic choices, unwillingness to tackle inequalities, and an uncoordinated system created a toxic cocktail that allowed the pandemic to turn into a catastrophic human crisis.”
The impact of the pandemic on human lives has been staggering. According to John Hopkins University, to date, more than 500 million people have been infected by the SARS-CoV-2 coronavirus or COVID-19, with 6.19 million deaths and counting.
What went wrong?
IPPPR says that public health officials, infectious disease experts and previous international commissions and reviews had already warned of potential pandemics and urged robust preparations since the first outbreak of SARS in 2003.
While SARS was an epidemic that only lasted about six months and resulted in 8,096 cases and 774 deaths, it was a novel coronavirus that caused respiratory disease which had travelled rapidly to 30 regions, infecting health workers and incapacitating healthcare systems. Fortunately, as the virus only transmitted to others several days after symptoms appeared, and it was at its most infectious when symptoms were most severe, the spread of SARS was more easily contained.
Since then, scientists have been studying the possibility of a new fast-moving pathogen that would be transmissible in the absence of symptoms, and posing a much deadlier challenge.
However, when the first cases of the COVID-19 outbreak appeared in Wuhan, China in late 2019, many did not take it seriously and failed to act swiftly enough to contain its rapid human-to-human transmission.
Zoonotic diseases and climate change
An article in Nature says that there have been more than six distinct influenza pandemics and epidemics in just over a century, and at least seven coronaviruses including the SARS-CoV-2. Ebola viruses alone have spilled over from animals to humans about 25 times in the past five decades.
About 75% of these newly emerging diseases, including COVID-19, are zoonotic or originate from animals, according to EcoHealth Alliance, a non-profit global environmental health organisation dedicated to protecting wildlife and public health from the emergence of disease.
Professor Wang Linfa, a Professor of Emerging Infectious Diseases at the DUKE-NUS Medical School, Singapore, shared at the Special Ministerial Conference for ASEAN Digital Public Health in October 2021 organised by Temasek Foundation that the drivers for the emergence of these viruses, though varied and complex, are largely human-induced. Some of the key drivers include climate change, encroachment of wildlife habitats, and urbanisation. Coupled with ease of global travel and lifting of trade bans, it has facilitated the rapid spread of these diseases.
“In the case of SARS-1 in 2002-03, the virus was harboured in bats. Civets played an important role as intermediate hosts before the virus transmitted, or spilled over, to humans. This was followed by human-to-human transmission. A similar route of emergence can be identified for SARS-2, or what we now know as the SARS-CoV-2 coronavirus, except in this case the human-to-human transmission has been very rapid and widespread,” explains Prof Wang, who is affectionately known as 'Bat Man’ by his colleagues and peers for his well-known fascination for, and expertise in bats and their unusual relationships with viruses.
However, what largely differentiates the SARS-CoV-2 coronavirus from its predecessor, says Prof Wang, is a process known as reverse zoonosis. In reverse zoonosis, the virus spills back from humans to an animal species, replicates and mutates, and can then spill over to humans again from the same animal species or a second intermediate species.
This second zoonotic transmission presents a challenge for scientists and the medical community as it can cause a new infectious disease outbreak, or what could potentially be SARS-3.
Preparing for the next large-scale virus outbreak
Scientists and infectious disease experts believe that the risk of another pandemic is a statistical certainty; it’s not so much a question of if, but when. The more pertinent question is: what are we going to do about it?
Hopefully, the lessons learned from COVID-19 will better prepare the international community to deal with a possible epidemic before it escalates into a global pandemic.
Prof Wang explains there are generally three stages of pandemic preparedness that should be implemented to effectively respond to the next coronavirus outbreak, or SARS-3:
1. Pre-emergence surveillance
Scientists are continuously studying animals and animal-human interfaces, to note any potential red flags in virus transmissions and potential threats. This data is shared on collaboration platforms, which are central to scientific exchange, and has enabled near-instant global availability of information.
Open data and open science collaboration were central to alert and response in the wake of COVID-19. During the first SARS outbreak in 2003, it took scientists almost three months to understand the virus’ entire genetic makeup, or genome. In contrast, when SARS-CoV-2 was identified in China in January 2020, the virus’ genome was published online within days.
2. Early warning stage
This is when early warning signs of human infections are noted. The latest technology in genome sequencing and epidemic surveillance already exists. Although fast-paced information and data-sharing made it possible to identify the SARS-CoV-2 virus and alert global epidemic surveillance networks within days of the Wuhan outbreak, there is still room for improvement.
In its report, the IPPPR suggests surveillance and alert systems at national, regional and global levels must be redesigned to bring together their detection functions and relay functions, to ensure potential outbreaks are not only picked up quickly but also acted upon swiftly by the international community. The application of digital tools and systems, as well as transparent data sharing are keys to achieving this.
3. Effective countermeasures
If the relevant bodies fail to act swiftly and contain the virus in the first two stages, and the virus starts to spread rapidly, the third step is to mobilise therapeutics and vaccines. The lessons we have learned from COVID-19 show that we cannot wait until there is a full-blown pandemic on our hands to mobilise therapeutics and vaccines; it is imperative to deploy this before the pandemic escalates, also known as ‘pre-emptive development’.
It was the sharing of the genome sequence of the novel coronavirus on an open platform that led to the most rapid creation of diagnostic tests in history. This then led to COVID-19 vaccines being developed at unprecedented speeds. Advances in technology also brought down the costs of genome sequencing and made machines that are small enough to fit in the palm of one’s hand, making it possible for large number of samples to be sequenced around the world.
Based on the IPPPR report, the return on investment in pandemic preparedness is significant. In contrast to the global impact of the COVID-19 pandemic at US$22 trillion (at the time of publishing in May 2021), the estimated cost for preparedness is just US$72 billion or less than 1% of the total cost as we know it.
The COVID-19 pandemic has exposed conspicuous gaps in international pandemic preparedness and response when confronted with the reality of a fast-moving virus. While tools, technologies and systems had largely been put in place to identify and escalate potential virus outbreaks, the pace at which action was taken on an international level was delayed, disjointed, and lacked agility, resulting in a humanitarian and socioeconomic crisis of global proportions.
There is an urgent need for a total reform of current pandemic preparedness and response procedures before the next coronavirus outbreak hits. For that to happen, pandemic preparedness must become a core function of governments and international communities, so that we can have a better shot at containing the next epidemic before it escalates into a full-blown pandemic.
*Disease X is a placeholder name that was adopted by the World Health Organization (WHO) in February 2018 on their shortlist of blueprint priority diseases to represent a hypothetical, unknown pathogen that could cause a future epidemic.
Article is written by Bridges M&C Account Director Hyma Haridas